Abstract 1811: Renoprotective Effect of Preoperative Statins in Coronary Artery Bypass Grafting
Background: A 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statins) has been shown to have not only a lipid lowering effect but a pleiotropic effect on inflammation, endothelial function and coagulation. However, the renoprotective effect of preoperative use of statins on the outcome of coronary artery bypass grafting has been ill-defined.
Method: We performed a retrospective review of 1802 consecutive patients undergoing isolated coronary artery bypass grafting between January 2002 and October 2005. 1039 patients were on a statin preoperatively and 763 patients were not. Two propensity score-matched cohorts each of 641 patients (statin and non-statin groups) were constructed and operative outcomes compared. Additionally, logistic regression analysis was performed to identify predictors of postoperative complications. Preoperative and postoperative renal insufficiency was defined based on the Society of Thoracic Surgeons database definitions.
Result: The statin group had less incidence of new postoperative renal insufficiency than the non-statin group (1.6% vs 3.9%, p = 0.01). There was no significant difference in operative mortality, perioperative myocardial infarction, stroke, deep sternal infection, respiratory failure, new atrial fibrillation and length of hospital stay between the groups. Logistic regression analysis showed that preoperative statin use (odds ratio [OR]: 0.55, 95% confidential interval [CI]: 0.30 – 0.98, p = 0.045), renal insufficiency (OR: 2.8, 95%CI: 1.3– 6.0, p = 0.01), New York Heart Association class (OR: 1.4, 95%CI: 1.03–1.9, p = 0.035) and cardiopulmonary bypass time (OR 1.01, 95%CI: 1.002–1.013, p = 0.013) were significant predictors of new postoperative renal insufficiency. In the patient subgroup without preoperative renal insufficiency, preoperative statin use was a significant predictor of postoperative renal insufficiency (OR: 0.49, 95%CI: 0.26 – 0.95, p= 0.035). In the patient subgroup with non-dialysis renal insufficiency, it was not a significant predictor of postoperative dialysis.
Conclusion: Preoperative statin use may be renoprotective after coronary artery bypass grafting especially in patients with normal preoperative renal function.